How Virtual Reality Reduces Preoperative Anxiety in Children

Virtual reality reduces preoperative anxiety for children at VCU

Ninety-one percent of children participating in a recent clinical study reported they would use virtual reality again, and 89% said the technology helped manage their anxiety while waiting for surgery, VCU Health reported.

For a child, the hour spent in a preoperative holding area—often filled with the clinical sights of IV placements and vital sign monitoring—can be a period of intense distress. While doctors traditionally rely on calming medicines to manage this fear, these medications carry risks, including slowed breathing and unexpected physiological reactions. A new study led by researchers at Virginia Commonwealth University (VCU) suggests a digital alternative: immersive virtual reality (VR) worlds designed to block out the hospital environment and replace it with calm, controlled experiences.

The findings, recently published in PLOS Digital Health, indicate that VR is not just a novelty for kids, but a feasible and safe tool that can be integrated into the routine workflow of a busy surgical unit.

A digital escape from the clinical environment

The initiative began with Narendra Vadlamudi, M.D., a gastroenterologist at Children’s Hospital of Richmond at VCU (CHoR), who sought ways to help children cope with the anxiety of waiting for anesthesia. While his initial vision involved a themed “water park ride” to simulate the path of an endoscopy, the project evolved through a partnership with Dayanjan Wijesinghe, Ph.D., an associate professor at the VCU School of Pharmacy.

Rather than a one-off experiment, the team spent nine months building a custom, child-friendly VR experience that could function within the everyday care of a surgical unit. The study involved 80 children, ages 6 to 15, who were given a choice between two distinct virtual environments during their average nine-minute sessions:

A familiar children’s room: A space filled with interactive toys that responded to the child’s gaze or controller, set against a backdrop of soft blues and greens with music timed to a resting heart rate of 60–70 beats per minute.
A beach scene: A calming landscape featuring gentle waves, palm trees, drifting clouds, and ambient ocean sounds.

To ensure the experience was shared, parents were able to view exactly what their child was seeing via a tablet, allowing them to participate in the calming process.

Children report less fear after VR sessions

Researchers measured heart rate and blood pressure before and after the sessions, finding that children reported less distress and fear following the experience. Most notably, the physiological data showed lower average heart rates and blood pressure levels after the VR sessions compared to their initial screenings. The data also revealed a specific pattern: children who entered the session with the highest levels of anxiety experienced the most significant drops in stress levels afterward.

“The goal is to keep the child as comfortable as possible. The care and overall patient and family experience are both better when children are more comfortable,” Vadlamudi said.

The practical benefits were echoed by the hospital staff. Siri Garrett, a certified child life specialist, noted that the novelty of the VR headsets often distracted children so completely that they tolerated IV placement with much less struggle. The clinical integration also proved efficient, with 83% of nurses rating the system as extremely easy to manage within their existing duties.

The potential for long-term recovery outcomes

High stress levels before surgery are clinically linked to more difficult anesthesia induction, higher risks of agitation upon waking, increased post-operative pain, and longer recovery times.

Wijesinghe emphasized that the technology is an option to be used alongside existing approaches, particularly when medication is necessary.

Looking ahead, the team aims to expand the application of this technology to other high-stress areas of pediatric care, such as infusion centers and hematology/oncology units, where children frequently require blood draws or access to ports.